Life stress and cortisol reactivity: An exploratory analysis of the effects of stress exposure across life on HPA-axis functioning

Retrospective Analysis of Fibromyalgia: Exploring the Interplay Between Various Triggers and Fibromyalgia's Severity

OBJECTIVES

This study aimed to explore the diverse etiological factors associated with fibromyalgia (FM), including trauma, stress, infections, and head injuries, and investigate their potential correlation with FM severeness manifestation, aiming to discern FM subgroups.

METHODS

The study was a retrospective analysis, conducted with data of 182 FM patients. Each patient's medical history was analyzed to identify a primary etiological event preceding FM. Following this, correlations were examined between each etiology group and different measurements, such as the impact of FM on overall function, widespread pain, depression, anxiety, and cognitive impairments. Cluster analysis was conducted to distinguish between groups of symptoms and functioning.

RESULTS

Contrary to the initial hypothesis, no direct association between a specific trigger and symptom manifestation was identified. However, cluster analyses revealed 2 distinct profiles based on symptom severity. Emotional trauma emerged as a potential contributor to heightened symptom severity, impacting overall function and cognitive abilities.

DISCUSSION

Emotional trauma and stress are crucial factors exacerbating FM symptoms, highlighting the importance of managing these elements in FM patients. This study underscores the complexity of FM, necessitating a nuanced understanding of its etiology and symptomatology. We recommend a multidisciplinary treatment approach that includes assessing and addressing chronic stress and trauma and incorporating stress management interventions to improve patient outcomes.

Adrenocortical deviations and adverse clinical outcomes in children and adolescents exposed to interparental intimate partner violence: A systematic review

Childhood exposure to interparental intimate partner violence (i-IPV) is a pervasive form of child maltreatment, posing major public health concerns and elevating risks for enduring adverse clinical and developmental consequences. However, assessing the full spectrum of clinical effects is challenging, potentially leading to inconsistent identification of children in need of early intervention. This systematic review aimed to identify hypothalamic-pituitary-adrenocortical axis dysfunction following i-IPV exposure, elucidating the underlying biopsychobehavioural mechanisms and predicting adverse outcomes. We searched Embase, MEDLINE, and PsycINFO for peer-reviewed studies from infancy through adolescence, screened reference lists and conducted forward searches. Analysis of 23 publications (N = 1848) revealed associations between i-IPV and altered adrenocortical function from early childhood, influenced by FKBP5 haplotype, parental caregiving and offspring emotional insecurity. Results showed that the adrenocortical stress response may predict internalising and externalising problems, childhood asthma, impaired executive function and poor academic performance. Nonetheless, inconsistencies in findings between studies suggest methodological heterogeneity and potential bias. Identifying biomarkers such as cortisol can enhance prediction and mechanism-based intervention efforts but long-term studies with a common theoretical and methodological framework are needed for comprehensive understanding. Integrating biological, emotional, and behavioural assessments could potentiate trauma services and research, ultimately improving outcomes for affected children.

Maternal separation as early-life stress: Mechanisms of neuropsychiatric disorders and inspiration for neonatal care

The establishment of positive early parent-infant relationships provide essential nourishment and social stimulation for newborns. During the early stages of postnatal brain development, events such as synaptogenesis, neuronal maturation and glial differentiation occur in a highly coordinated manner. Maternal separation, as an early-life stress introducer, can disrupt the formation of parent-child bonds and exert long-term adverse effects throughout life. When offspring are exposed to maternal separation, the body regulates the stress of maternal separation through multiple mechanisms, including neuroinflammatory responses, neuroendocrinology, and neuronal electrical activity. In adulthood, early maternal separation has long-term effects, such as the induction of neuropsychiatric disorders such as anxiety, depression, and cognitive dysfunction. This review summarized the application of maternal separation models and the mechanisms of stress system response in neuropsychiatric disorders, serving as both a reminder and inspiration for approaches to improve neonatal care, "from bench to bedside".

Reconsidering the nature of threat in infancy: Integrating animal and human studies on neurobiological effects of infant stress

Early life stress has been associated with elevated risk for later psychopathology. One mechanism that may contribute to such long-term risk is alterations in amygdala development, a brain region critical to stress responsivity. Yet effects of stress on the amygdala during human infancy, a period of particularly rapid brain development, remain largely unstudied. In order to model how early stressors may affect infant amygdala development, several discrepancies across the existing literatures on early life stress among rodents and early threat versus deprivation among older human children and adults need to be reconciled. We briefly review the key findings of each of these literatures. We then consider them in light of emerging findings from studies of human infants regarding relations among maternal caregiving, infant cortisol response, and infant amygdala volume. Finally, we advance a developmental salience model of how early threat may impact the rapidly developing infant brain, a model with the potential to integrate across these divergent literatures. Future work to assess the value of this model is also proposed.

Effects of social environments on male primate HPG and HPA axis developmental programming

Developmental plasticity is particularly important for humans and other primates because of our extended period of growth and maturation, during which our phenotypes adaptively respond to environmental cues. The hypothalamus-pituitary-gonadal (HPG) and hypothalamus-pituitary-adrenal (HPA) axes are likely to be principal targets of developmental "programming" given their roles in coordinating fitness-relevant aspects of the phenotype, including sexual development, adult reproductive and social strategies, and internal responses to the external environment. In social animals, including humans, the social environment is believed to be an important source of cues to which these axes may adaptively respond. The effects of early social environments on the HPA axis have been widely studied in humans, and to some extent, in other primates, but there are still major gaps in knowledge specifically relating to males. There has also been relatively little research examining the role that social environments play in developmental programming of the HPG axis or the HPA/HPG interface, and what does exist disproportionately focuses on females. These topics are likely understudied in males in part due to the difficulty of identifying developmental milestones in males relative to females and the general quiescence of the HPG axis prior to maturation. However, there are clear indicators that early life social environments matter for both sexes. In this review, we examine what is known about the impact of social environments on HPG and HPA axis programming during male development in humans and nonhuman primates, including the role that epigenetic mechanisms may play in this programming. We conclude by highlighting important next steps in this research area.

Maltreatment type differences in cortisol stress response trajectories across adolescence

This study examined cortisol stress response trajectories across adolescence in 454 maltreated and comparison youth recruited from Los Angeles County between 2002 and 2005 (66.7% maltreated; 46.7% girls; 39.0% Latino; 37.7% Black; 12.3% Mixed or Biracial; 11.0% White; Mage = 10.9 years, SD = 1.2). Adolescents' peak activation and cortisol reactivity and recovery slopes following the Trier Social Stress Test for Children were calculated at four waves, then used to model peak activation and cortisol reactivity and recovery trajectories arrayed by age. Maltreated youth had blunted cortisol reactivity at age 9 relative to comparison youth (b = -.19, p = .02). Sexually and physically abused youth showed blunted cortisol reactivity and recovery trajectories relative to emotionally abused and neglected youth.

Analysis of the Effect of Exams on Perceived Stress and Temporomandibular Joint Status in Physiotherapy Students: A Pilot Study

Background and Objectives: Temporomandibular disorders or dysfunction (TMDs) encompass a range of complex conditions that impact the temporomandibular joint (TMJ), chewing muscles, teeth, and/or their supporting tissues. Stress is one of the most associated factors studied as a TMD predictor. The aim is to figure out the influence of stress on TMJ status and salivary cortisol in university students during and before exams. Materials and Methods: The study was non-experimental, employing a longitudinal, analytical, observational cohort design. The study population consisted of students enrolled in the physiotherapy degree program at the Alfonso X El Sabio University (Madrid, Spain). Data were collected during two distinct academic periods: the first period was characterized by low academic stress and no exams, and the second period coincided with the high academic stress of final course exams. The collected results included sociodemographic data, assessment of TMJ status (Fonseca Index), evaluation of muscle evaluation (masseter, upper trapezius, and sternocleidomastoid) using a MOXY Monitor (muscle oxygenation) and Neurotrac® (surface EMG, sEMG), assessment of perceived stress (PSS-14), and measurement of salivary cortisol (enzyme immunoassay with Elisa). The statistical analysis was conducted with a confidence level of 95% (p ≤ 0.05) and asymptotic or bilateral significance. Results: 70 students were analyzed during two different measurement periods. According to the Fonseca Index, initially, 37.14% of the analyzed students showed mild TMDs, 17.14% moderate TMDs, and 45.72% showed no TMDs. In general terms, stress increased with age and is related to female sex, maximum mouth opening decreased with age, oxygen saturation decreased with age and academic stress, and myoglobin concentration was related to age. Furthermore, muscle contraction decreased during higher academic stress and increased with age. For women, age was a risk factor for suffering from TMDs, and stress worsened the transition from having TMDs to having no TMDs in both sexes. Conclusions: Academic stress influences TMJ status and muscle outcomes such as oxygen saturation, myoglobin concentration, and muscle contraction, although more research is needed.

Life stress influences the relationship between sex hormone fluctuation and affective symptoms in peripubertal female adolescents

Female adolescents have a greatly increased risk of depression starting at puberty, which continues throughout the reproductive lifespan. Sex hormone fluctuation has been highlighted as a key proximal precipitating factor in the development of mood disorders tied to reproductive events; however, hormone-induced affective state change is poorly understood in the pubertal transition. The present study investigated the impact of recent stressful life events on the relationship between sex hormone change and affective symptoms in peripubertal female participants. Thirty-five peripubertal participants (ages 11-14, premenarchal, or within 1 year of menarche) completed an assessment of stressful life events, and provided weekly salivary hormone collections [estrone, testosterone, dehydroepiandrosterone (DHEA)] and mood assessments for 8 weeks. Linear mixed models tested whether stressful life events provided a context in which within-person changes in hormones predicted weekly affective symptoms. Results indicated that exposure to stressful life events proximal to the pubertal transition influenced the directional effects of hormone change on affective symptoms. Specifically, greater affective symptoms were associated with increases in hormones in a high stress context and decreases in hormones in a low stress context. These findings provide support for stress-related hormone sensitivity as a diathesis for precipitating affective symptoms in the presence of pronounced peripubertal hormone flux.

Insights into child abuse and neglect: Findings from the Minnesota Longitudinal Study of Risk and Adaptation

The Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) is a landmark prospective, longitudinal study of human development focused on a sample of mothers experiencing poverty and their firstborn children. Although the MLSRA pioneered a number of important topics in the area of social and emotional development, it began with the more specific goal of examining the antecedents of child maltreatment. From that foundation and for more than 40 years, the study has produced a significant body of research on the origins, sequelae, and measurement of childhood abuse and neglect. The principal objectives of this report are to document the early history of the MLSRA and its contributions to the study of child maltreatment and to review and summarize results from the recently updated childhood abuse and neglect coding of the cohort, with particular emphasis on findings related to adult adjustment. While doing so, we highlight key themes and contributions from Dr Dante Cicchetti's body of research and developmental psychopathology perspective to the MLSRA, a project launched during his tenure as a graduate student at the University of Minnesota.

Current and Cumulative Stress Experiences: A Model for Arab American Young Adults

BACKGROUND

The effect of multiple stressors on immigrant young adults' endocrine functioning and health outcomes has not been comprehensively investigated.

AIMS

This study tested a theoretical model of cumulative and current stressor effects on the hypothalamic-pituitary-adrenocortical (HPA) axis functioning and health-related quality of life (HRQL) among Arab American young adults.

METHODS

Using a cross-sectional design, we recruited 160 participants, ages 18 to 24 years, from an urban university in the Midwest. Cumulative stress was assessed by self-report measures of childhood adversity, bullying victimization, and perceived ethnic discrimination. Current perceived stress was measured using the Perceived Stress Scale (PSS) while cortisol levels were measured in participants' hair. Structural equation modeling tested the effects of cumulative and current stress on cortisol and HRQL.

RESULTS

Cumulative stress was negatively associated with HRQL (standardized path coefficient = -.51, p < .05). Interestingly, however, cumulative stress was inversely associated with hair cortisol level (standardized path coefficient = -.51, p < .05). Current stress was positively associated with cortisol level (standardized path coefficient = .43, p < .05) and negatively associated with the mental HRQL (standardized path coefficient < -.37, p < .05).

CONCLUSION

Cumulative stress exhibited a different effect on HPA functioning from current perceived stress. Mental health was significantly impaired by both cumulative and current perceived stress. Implications for mental health nursing practice and research among Arab Americans are discussed.

The effect of cognitive reappraisal and early-life maternal care on neuroendocrine stress responses

Early-life adversity (ELA) is related to profound dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, reflected in both, blunted or exaggerated cortisol stress responses in adulthood. Emotion regulation strategies such as cognitive reappraisal might contribute to this inconsistent finding. Here, we investigate an interaction of early-life maternal care (MC), where low MC represents a form of ELA, and instructed emotion regulation on cortisol responses to acute stress. Ninety-three healthy young women were assigned to a low (n = 33) or high (n = 60) MC group, based on self-reported early-life MC. In the laboratory, participants received regulation instructions, asking to cognitively reappraise (reappraisal group, n = 45) or to focus on senses (control group, n = 48) during subsequent stress exposure, induced by the Trier Social Stress Test. Salivary cortisol and subjective stress levels were measured repeatedly throughout the experiment. Multilevel model analyses confirmed a MC by emotion regulation interaction effect on cortisol trajectories, while controlling for hormonal status. Individuals with low MC in the control compared with the reappraisal group showed increased cortisol responses; individuals with high MC did not differ. These results highlight the significance of emotion regulation for HPA axis stress regulation following ELA exposure. They provide methodological and health implications, indicating emotion regulation as a promising target of treatment interventions for individuals with a history of ELA.

Lead exposure, glucocorticoids, and physiological stress across the life course: A systematic review

The biological pathways linking lead exposure to adverse outcomes are beginning to be understood. Rodent models suggest lead exposure induces dysfunction within the hypothalamic-pituitary-adrenal (HPA) axis and glucocorticoid regulation, a primary physiological stress response system. Over time, HPA axis and glucocorticoid dysfunction has been associated with adverse neurocognitive and cardiometabolic health, much like lead exposure. This systematic review utilized PRISMA guidelines to synthesize the literature regarding associations between lead exposure and downstream effector hormones of the HPA axis, including cortisol, a glucocorticoid, and dehydroepiandrosterone (DHEA), a glucocorticoid antagonist. We additionally determined the state of the evidence regarding lead exposure and allostatic load, a measure of cumulative body burden resultant of HPA axis and glucocorticoid dysfunction. A total of 18 articles were included in the review: 16 assessed cortisol or DHEA and 3 assessed allostatic load. Generally, the few available child studies suggest a significant association between early life lead exposure and altered cortisol, potentially suggesting the impact of developmental exposure. In adulthood, only cross sectional studies were available. These reported significant associations between lead and reduced cortisol awakening response and increased cortisol reactivity, but few associations with fasting serum cortisol. Two studies reported significant associations between increasing lead exposure and allostatic load in adults and another between early life lead exposure and adolescent allostatic load. The paucity of studies examining associations between lead exposure and allostatic load or DHEA and overall heterogeneity of allostatic load measurements limit conclusions. However, these findings cautiously suggest associations between lead and dysregulation of physiological stress pathways (i.e., glucocorticoids) as seen through cortisol measurement in children and adults. Future research would help to elucidate these associations and could further examine the physiological stress pathway as a mediator between lead exposure and detrimental health outcomes.

Unveiling Wide Spectrum Therapeutic Implications and Signaling Mechanisms of Valsartan in Diverse Disorders: A Comprehensive Review

Valsartan is an orally active non-peptide angiotensin receptor antagonist, an effective and well-tolerated anti-hypertensive drug. Besides its antihypertensive action, it has clinical implications in many other disorders, like heart failure (HF), arrhythmia, chronic kidney disease (CKD), diabetic complications (DM), atherosclerosis, etc. Besides angiotensin receptor blocking activity, valsartan reduces circulating levels of biochemical markers, such as hs-CRP, which is responsible for its anti-inflammatory and anti-oxidant activity. Moreover, valsartan also acts by inhibiting or inducing various signalling pathways, such as inducing autophagy via the AKT/mTOR/S6K pathway or inhibiting the TLR/NF-kB pathway. The current review exhaustively discusses the therapeutic implications of valsartan with specific emphasis on the mechanism of action in various disorders. The article provides a detailed spectrum of the therapeutic profile of valsartan and will likely be very useful to researchers working in the relevant research areas.

Ventromedial hypothalamus relays chronic stress inputs and exerts bidirectional regulation on anxiety state and related sympathetic activity

Chronic stress can induce negative emotion states, including anxiety and depression, leading to sympathetic overactivation and disturbed physiological homeostasis in peripheral tissues. While anxiety-related neural circuitry integrates chronic stress information and modulates sympathetic nervous system (SNS) activity, the critical nodes linking anxiety and sympathetic activity still need to be clarified. In our previous study, we demonstrated that the ventromedial hypothalamus (VMH) is involved in integrating chronic stress inputs and exerting influence on sympathetic activity. However, the underlying synaptic and electrophysiological mechanisms remain elusive. In this study, we combined in vitro electrophysiological recordings, behavioral tests, optogenetic manipulations, and SNS activity analyses to explore the role of VMH in linking anxiety emotion and peripheral SNS activity. Results showed that the VMH played an important role in bidirectionally regulating anxiety-like behavior and peripheral sympathetic excitation. Chronic stress enhanced excitatory inputs into VMH neurons by strengthening the connection with the paraventricular hypothalamus (PVN), hence promoting anxiety and sympathetic tone outflow, an important factor contributing to the development of metabolic imbalance in peripheral tissues and cardiovascular diseases.

Adolescents' hair cortisol concentrations during COVID-19: Evidence from two longitudinal studies in the Netherlands and the United States

BACKGROUND

Prolonged stress exposure is associated with alterations in cortisol output. The COVID-19 pandemic represented a stressor for many, including children. However, a high-quality caregiving environment may protect against psychological problems and possibly against elevations in cortisol. We examined adolescents' physiological stress responses to the pandemic and the role of attachment in two longitudinal samples from the Netherlands and the United States (https://aspredicted.org/HHY_8MK).

METHODS

Cortisol was assessed from hair samples before and during the pandemic, while attachment was self-reported prepandemic. Study 1 included a Dutch sample (N = 158; examined at ages 10 and later at 14 years old), whereas Study 2 included a US sample (N = 153; examined at ages 9-11 and again 2 years later) and an age-matched prepandemic sample (N = 29, 10-13 years old). Repeated-measures analyses of variance examined changes in cortisol from prepandemic to during the pandemic and the effect of attachment in each sample separately.

RESULTS

After accounting for age, both studies revealed nonsignificant changes in hair cortisol and a nonsignificant effect of attachment. A significant effect of sex emerged in Study 1, with Dutch girls showing a significant cortisol increase during the pandemic, which was not explained by puberty.

CONCLUSION

These findings suggest differential associations of the pandemic with hair cortisol increases by sex and country.

Disrupting links between poverty, chronic stress, and educational inequality

The income-achievement gap is a significant and stubborn problem in the United States, which has been exacerbated by the Covid-19 pandemic. In this article, we link two emerging literatures that have historically been disparate: the neurobiology of poverty as a form of early life stress, and research on educational policies with the potential to reduce SES-based disparities in academic achievement. In doing so, we (1) integrate the literature on poverty-related mechanisms that contribute to early life stress, alter neurobiology, and lead to educational inequities, and (2) based on this research, highlight policies and practices at the school/classroom level and broader structural level that have the potential to address the problem of inequity in our educational systems. We emphasize that educational inequity is a systemic issue, and its resolution will require coordination of local, state, and national policies.

Prenatal serotonin reuptake inhibitor antidepressant exposure, SLC6A4 genetic variations, and cortisol activity in 6-year-old children of depressed mothers: A cohort study

Prenatal exposure to maternal depression and serotonin reuptake inhibitor (SRI) antidepressants both affect the development of the hypothalamic-pituitary-adrenal (HPA) system, possibly via the neurotransmitter serotonin (5HT). In a community cohort, we investigated the impact of two factors that shape prenatal 5HT signaling (prenatal SRI [pSRI] exposure and child SLC6A4 genotype) on HPA activity at age 6 years. Generalized estimating equation (GEE) models were used to study associations between cortisol reactivity, pSRI exposure, and child SLC6A4 genotype, controlling for maternal depression, child age, and sex (48 pSRI exposed, 74 nonexposed). Salivary cortisol levels were obtained at five time points during a laboratory stress challenge: arrival at the laboratory, following two sequential developmental assessments, and then 20 and 40 min following the onset of a stress-inducing cognitive/social task. Cortisol decreased from arrival across both developmental assessments, and then increased across both time points following the stress challenge in both groups. pSRI-exposed children had lower cortisol levels across all time points. In a separate GEE model, we observed a lower cortisol stress response among children with LG /S alleles compared with children with La/La alleles, and this was particularly evident among children of mothers reporting greater third trimester depressed mood. Our findings suggest that pSRI exposure and a genetic factor associated with modulating 5HT signaling shaped HPA reactivity to a laboratory stress challenge at school age.

Testing adverse childhood experiences (ACEs) as a potential moderator of the association between current chronic stress and cardiovascular reactivity

Motivated by mixed findings regarding the relationship between chronic stress and cardiovascular reactivity, the current study aimed to investigate whether adverse childhood experiences (ACEs) serve as a potential moderator of the association between current chronic stress and cardiovascular reactivity. Incidence of ACEs, levels of current chronic stress, and heart rate (HR) reactivity to a mental arithmetic stress task were measured in 111 participants (age = 20.83, 76 % female, 66 % White). ACEs were measured using the Childhood Trauma Questionnaire and current chronic stress was measured using the Perceived Stress Scale. Moderation analyses were conducted with HR reactivity as the outcome and ACEs as the moderator. Results indicated that a greater amount of current chronic stress was significantly associated with relatively blunted HR reactivity (β = -0.25, p = 0.03) even after controlling for sociodemographic variables. Exposure to ACEs was not significantly related to HR reactivity, (all p ≥ 0.66), and there was no significant interaction between current chronic stress and ACE exposure in predicting HR reactivity, (all p ≥ 0.44). These results show that current chronic stress is associated with relatively blunted HR reactivity and that exposure to ACEs does not moderate the relationship between chronic stress and cardiac stress reactivity.

Exposure to the Indian Ocean Tsunami shapes the HPA-axis resulting in HPA "burnout" 14 years later

Despite significant research on the effects of stress on the hypothalamic-pituitary-adrenal (HPA) axis, questions remain regarding long-term impacts of large-scale stressors. Leveraging data on exposure to an unanticipated major natural disaster, the 2004 Indian Ocean tsunami, we provide causal evidence of its imprint on hair cortisol levels fourteen years later. Data are drawn from the Study of the Tsunami Aftermath and Recovery, a population-representative longitudinal study of tsunami survivors who were living along the coast of Aceh, Indonesia, when the tsunami hit. Annual rounds of data, collected before, the year after and 2 y after the disaster provide detailed information about tsunami exposures and self-reported symptoms of post-traumatic stress. Hair samples collected 14 y after the tsunami from a sample of adult participants provide measures of cortisol levels, integrated over several months. Hair cortisol concentrations are substantially and significantly lower among females who were living, at the time of the tsunami, in communities directly damaged by the tsunami, in comparison with similar females living in other, nearby communities. Differences among males are small and not significant. Cortisol concentrations are lowest among those females living in damaged communities who reported elevated post-traumatic stress symptoms persistently for two years after the tsunami, indicating that the negative effects of exposure were largest for them. Low cortisol is also associated with contemporaneous reports of poor self-rated general and psychosocial health. Taken together, the evidence points to dysregulation in the HPA axis and "burnout" among these females fourteen years after exposure to the disaster.

Associations of prenatal maternal depressive symptoms with cord blood glucocorticoids and child hair cortisol levels in the project viva and the generation R cohorts: a prospective cohort study

BACKGROUND

Prior studies have reported conflicting results regarding the association of prenatal maternal depression with offspring cortisol levels. We examined associations of high levels of prenatal depressive symptoms with child cortisol biomarkers.

METHODS

In Project Viva (n = 925, Massachusetts USA), mothers reported their depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy, cord blood glucocorticoids were measured at delivery, and child hair cortisol levels were measured in mid-childhood (mean (SD) age: 7.8 (0.8) years) and early adolescence (mean (SD) age: 13.2 (0.9) years). In the Generation R Study (n = 1644, Rotterdam, The Netherlands), mothers reported depressive symptoms using the Brief Symptom Inventory (BSI) during pregnancy, and child hair cortisol was measured at a mean (SD) age of 6.0 (0.5) years. We used cutoffs of ≥ 13 for the EPDS and > 0.75 for the BSI to indicate high levels of prenatal depressive symptoms. We used multivariable linear regression models adjusted for child sex and age (at outcome), and maternal pre-pregnancy BMI, education, social support from friends/family, pregnancy smoking status, marital status, and household income to assess associations separately in each cohort. We also meta-analyzed childhood hair cortisol results from both cohorts.

RESULTS

8.0% and 5.1% of women respectively experienced high levels of prenatal depressive symptoms in Project Viva and the Generation R Study. We found no associations between high levels of maternal depressive symptoms during pregnancy and child cortisol biomarkers in either cohort.

CONCLUSIONS

The present study does not find support for the direct link between high levels of maternal depressive symptoms and offspring cortisol levels.

Race, cortisol, and subclinical cardiovascular disease in 9- to 11-year-old children

BACKGROUND

Non-Hispanic Black Americans have a greater risk for certain subtypes of cardiovascular disease (CVD; e.g., stroke and heart failure) relative to non-Hispanic White Americans. Moreover, Black relative to White adults consistently show elevated cortisol, a CVD risk. The impact of race, environmental stress, and cortisol on subclinical CVD has yet to be fully researched in children.

METHOD

We assessed diurnal salivary cortisol slopes and hair cortisol in a sample of 9- to 11-year-old children (N = 271; 54% female) with roughly half self-identifying as either Black (57%) or White (43%). Two subclinical CVD indicators were assessed: carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT). We assessed numerous environmental stress indicators.

RESULTS

After adjusting for covariates, we found that Black children had significantly flatter diurnal cortisol slopes, higher hair cortisol, and thicker IMT than White children. Significant pathways were found: race → salivary cortisol slope → cfPWV (effect = -0.059, 95% CI [-0.116, -0.002]) and race → hair cortisol → cIMT (effect = -0.008, [-0.016, -0.002]). Black children also experienced significantly more environmental stress than White children; however, only income inequality served as a significant indirect pathway from race to salivary cortisol (effect = 0.029, [0.003, 0.060]).

CONCLUSIONS

Relative to White children, Black children had significantly greater hair cortisol and flatter diurnal slopes which, in turn, were associated with greater subclinical CVD. As suggested by a significant indirect pathway, income inequality might partially explain the race-cortisol association. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Hypocortisolemic reactivity to acute social stress among lonely young women

We examined biopsychosocial stress of acute social pain in relation to chronic loneliness. Hypotheses: 1) Cyberball exclusion (vs. inclusion) would be associated with lower cortisol reactivity to a speech task, and 2) loneliness would moderate the relationship between social exclusion and cortisol reactivity to a speech task, such that higher loneliness would be linked to lower cortisol. Participants (n = 31, women, aged 18-25, 51.6% non-Hispanic white) were randomized to be excluded or included in a game of Cyberball, then completed a speech task. Salivary cortisol was measured at baseline, pre-speech, post-speech, and 15 minutes post-speech. Cortisol reactivity was calculated using area under the curve-increase (AUCi). ANOVA revealed a non-significant, meaningful effect of Cyberball exclusion on cortisol AUCi (p=.103, ηp2=.10), accounting for contraceptive use. Moderation analysis revealed among women with high loneliness, women in the exclusion condition had significantly lower cortisol reactivity than women in the inclusion condition (p=.001). For women with low and medium loneliness, there were no significant differences by Cyberball condition. In sum, lonely young women who are excluded may have hypocortisolemic responses to social stress. Results are consistent with literature suggesting that chronic stress is linked to lower cortisol responses, which is linked to negative physical health outcomes.

Continuity of psychopathology v. resilience across the transition to adolescence: role of hair cortisol and sensitive caregiving

BACKGROUND

The transition to adolescence implicates heightened vulnerability alongside increased opportunities for resilience. Contexts of early life stress (ELS) exacerbate risk; still, little research addressed biobehavioral mediators of risk and resilience across the adolescent transition following ELS. Utilizing a unique cohort, we tested biosocial moderators of chronicity in adolescents' internalizing disorders v. resilience.

METHOD

Families exposed to chronic war-related trauma, v. controls, were followed. We utilized data from three time-points framing the adolescent transition: late childhood (N = 177, Mage = 9.3 years ± 1.41), early adolescence (N = 111, Mage = 11 0.66 years ± 1.23), and late adolescence (N = 138, Mage = 15.65 years ± 1.31). In late childhood and late adolescence children's internalizing disorders were diagnosed. At early adolescence maternal and child's hair cortisol concentrations (HCC), maternal sensitivity, and mothers' post-traumatic symptoms evaluated.

RESULTS

War-exposed children exhibited more internalizing disorders of chronic trajectory and mothers were less sensitive and more symptomatic. Three pathways elucidated the continuity of psychopathology: (a) maternal sensitivity moderated the risk of chronic psychopathology, (b) maternal post-traumatic symptoms mediated continuity of risk, (c) trauma exposure moderated the association between child internalizing disorders at late childhood and maternal HCC, which linked with child HCC. Child HCC linked with maternal post-traumatic symptoms, which were associated with child disorders in late adolescence.

CONCLUSION

Results demonstrate the complex interplay of maternal and child's biosocial factors as mediators and moderators of risk chronicity across the adolescent transition following trauma. Findings are first to utilize maternal and child's HCC as biomarkers of chronic stress v. resilience during adolescence, a period of neural reorganization and personal growth that shapes the individual's lifetime adaptation.

Risk and protective factors for stress generation: A meta-analytic review

The stress generation hypothesis suggests that some individuals contribute more than others to the occurrence of dependent (self-generated), but not independent (fateful), stressful life events. This phenomenon is commonly studied in relation to psychiatric disorders, but effects are also driven by underlying psychological processes that extend beyond the boundaries of DSM-defined entities. This meta-analytic review of modifiable risk and protective factors for stress generation synthesizes findings from 70 studies with 39,693 participants (483 total effect sizes) from over 30 years of research. Findings revealed a range of risk factors that prospectively predict dependent stress with small-to-moderate meta-analytic effects (rs = 0.10-0.26). Negligible to small effects were found for independent stress (rs = 0.03-0.12), and, in a critical test for stress generation, most effects were significantly stronger for dependent compared to independent stress (βs = 0.04-0.15). Moderation analyses suggest effects of maladaptive interpersonal emotion regulation behaviors and repetitive negative thinking are stronger for interpersonal (versus non-interpersonal) stress; effects of repetitive negative thinking and excessive standards for self may be inflated by overreliance on self-report measures that fail to isolate psychological distress from objective experience. Findings have key implications for advancing stress generation theory and informing targets for intervention.

Early Life Stress in Mice Leads to Impaired Colonic Corticosterone Production and Prolonged Inflammation Following Induction of Colitis

BACKGROUND

Early life stress (ELS) is an environmental trigger believed to promote increased risk of IBD. Our goal was to identify mechanisms whereby ELS in mice affects susceptibility to and/or severity of gut inflammation.

METHODS

We utilized 2 published animal models of ELS. In the first model, newborn mice were separated from the dam daily for 4 to 8 hours starting on postnatal day 2 and then weaned early on postnatal day 17. Control mice were left undisturbed with the dams until weaning on postnatal day 21. In the second model, dams were fed dexamethasone or vehicle ad libitum in drinking water on postpartum days 1 to 14. Plasma and colonic corticosterone were measured in juvenile and adult mice. Colitis was induced in 4-week-old mice via intraperitoneal injection of interleukin (IL)-10 receptor blocking antibody every 5 days for 15 days. Five or 15 days later, colitis scores and transcripts for Tnf, glucocorticoid receptors, and steroidogenic enzymes were measured.

RESULTS

Mice exposed to ELS displayed reduced plasma and colonic corticosterone. Control animals showed improvements in indices of inflammation following cessation of interleukin-10 receptor blockade, whereas ELS-exposed animals maintained high levels of Tnf and histological signs of colitis. In colitic animals, prior exposure to ELS was associated with significantly lower expression of genes associated with corticosterone synthesis and responsiveness. Finally, TNF stimulation of colonic crypt cells from ELS mice led to increased inhibition of corticosterone synthesis.

CONCLUSIONS

Our study identifies impaired local glucocorticoid production and responsiveness as a potential mechanism whereby ELS predisposes to chronic colitis in susceptible hosts.

HPA-SAM co-activation among racially diverse, economically disadvantaged early adolescents: Secondary analysis with a preliminary test of a multisystem, person-centered approach

Investigating the co-activation of hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenomedullary (SAM) responses to acute stress can provide insight into how risk might become biologically embedded during early adolescence and improve understanding of what distinguishes physiological dysregulation from normative/expected physiological responses to stress. Evidence has thus far been mixed as to whether symmetric or asymmetric co-activation patterns are associated with higher exposure to chronic stress and poorer mental health outcomes during adolescence. This study expands on a prior multisystem, person-centered analysis of lower-risk, racially homogenous youth by focusing on HPA-SAM co-activation patterns in a higher-risk, racially diverse sample of early adolescents from low-income families (N = 119, Mage=11.79 years, 55.5% female, 52.7% mono-racial Black). The present study was conducted by performing secondary analysis of data from the baseline assessment of an intervention efficacy trial. Participants and caregivers completed questionnaires; youth also completed the Trier Social Stress Test-Modified (TSST-M) and provided six saliva samples. Multitrajectory modeling (MTM) of salivary cortisol and alpha-amylase levels identified four HPA-SAM co-activation profiles. In accordance with the asymmetric-risk model, youth exhibiting Low HPA-High SAM (n = 46) and High HPA-Low SAM (n = 28) profiles experienced more stressful life events, posttraumatic stress, and emotional and behavioral problems relative to Low HPA-Low SAM (n = 30) and High HPA-High SAM (n = 15) youth. Findings highlight potential differences in biological embedding of risk during early adolescence based on individuals' exposure to chronic stress and illustrate the utility of multisystem and person-centered approaches in understanding how risk might get "underneath the skin" across systems.

Thirty-year follow-up of the NICHD Study of Early Child Care and Youth Development (SECCYD): the challenges and triumphs of conducting in-person research at a distance

PURPOSE

The purpose of the current study, The National Institute of Child Health and Human Development (NICHD) Study of Health in Early and Adult Life (SHINE), was to build on the landmark Study of Early Child Care and Youth Development (SECCYD), a longitudinal birth cohort initiated in 1991, by conducting a health-focused follow-up of the now adult participants. This effort has produced an invaluable resource for the pursuit of life course research examining links between early life risk and resilience factors and adulthood health and disease risk.

PARTICIPANTS

Of the 927 NICHD SECCYD participants available for recruitment in the current study, 705 (76.1%) participated in the study. Participants were between 26 and 31 years and living in diverse geographic locations throughout the USA.

FINDINGS TO DATE

In descriptive analyses, the sample exhibited risk on health status indicators, especially related to obesity, hypertension and diabetes. Of particular concern, the prevalence of hypertension (29.4%) and diabetes (25.8%) exceeded national estimates in similar-age individuals. Health behaviour indicators generally tracked with the parameters of poor health status, showing a pattern of poor diet, low activity and disrupted sleep. The juxtaposition of the sample's relatively young age (mean=28.6 years) and high educational status (55.6% college educated or greater) with its poor health status is noteworthy, suggesting a dissociation between health and factors that are typically health protective. This is consistent with observed population health trends, which show a worsening of cardiometabolic health status in younger generations of Americans.

FUTURE PLANS

The current study, SHINE, lays the groundwork for future analyses in which the uniquely robust measures collected as a part of the original NICHD SECCYD will be leveraged to pinpoint specific early life risk and resilience factors as well as the correlates and potential mechanisms accounting for variability in health and disease risk indicators in young adulthood.

Early life stress, depression and epigenetics

Different factors are essential in increasing the vulnerability to psychiatric disorders, such as genetics. Among these factors, early life stress (ELS), including sexual, physical, emotional abuse, and emotional and physical neglect, enhances the odds of having menial conditions throughout life. Exhaustive research has shown that ELS leads to physiological changes, such as alteration in the HPA axis. During the most critical development period (childhood and adolescence), these changes increase the risk of having child-onset psychiatric disorders. Furthermore, research has suggested a relationship between early life stress and depression, particularly more prolonged episodes of depression with treatment-resistant outcomes. Molecular studies indicate that, in general, the hereditary character of psychiatric disorders is polygenic, multifactorial and highly complex, with innumerable low-effect genetic variants interacting with each other. However, whether there are independent effects among subtypes of ELS remains unclear. This article provides an overview of the interplay of epigenetics, the HPA axis, early life stress and the development of depression. Advances in our knowledge of epigenetics in the context of early life stress and depression provide a new understanding of the genetic influence on psychopathology. Furthermore, they could lead to identifying new targets for clinical intervention.

Childhood environment early life stress, caregiver warmth, and associations with the cortisol diurnal curve in adulthood: The coronary artery risk development in young adults (CARDIA) study

BACKGROUND

Early life stress (ELS) is associated with increased morbidity and mortality across the lifecourse. Studies observing a relationship between ELS and stress physiology (cortisol), may help explain the connection to poor health outcomes, but have been limited by cortisol measures used.

PURPOSE

We examined the association between ELS measured by a Risky Family (RF) environment questionnaire, and adult diurnal cortisol profile inclusive of multiple cortisol measures.

METHODS

RF and cortisol were collected from Coronary Artery Risk Development in Young Adults Study participants at follow-up (Year 15). Complete case (n = 672) data were included in multi-variable regression analyses with log transformed cortisol measures (outcomes) including wake-up cortisol, cortisol awakening response [CAR], AUC and five other cortisol diurnal curve measures.

RESULTS

Participants were age 39.9 + /- 3.7 years and 51.6% Black. For every 1 unit increase in RF, there was a 1.4% greater wake-up cortisol and flatter CAR after adjustment for age, sex, income, and smoking (B=0.014, p = 0.023; B=-0.014, p = 0.028, respectively). Each unit increase in caregiver warmth/affection was associated with a 6.9% higher (steeper) CAR (B=0.069, p = 0.03). Results remained significant after adjusting for other covariates except social support in adulthood. An interaction between child abuse and caregiver warmth was nearly significant (p = 0.068), such that for those with exposure to the greatest caregiver warmth and lowest child abuse, CAR was steepest CONCLUSIONS: We demonstrate that ELS is associated with altered cortisol regulation in adulthood. However, further research is needed to assess how healthy relationships throughout the life course may modulate cortisol regulation in adulthood.

Impact of social exclusion on empathy in women with borderline personality disorder

Unstable interpersonal relationships and fear of abandonment are core symptoms of borderline personality disorder (BPD) that often intensify during stress. Psychosocial stress, which includes components of social exclusion and increases cortisol secretion, enhances emotional empathy in healthy individuals. Women with BPD, on the contrary, react with reduced emotional empathy. The aim of the present study was to investigate the effects of perceived social exclusion without accompanying cortisol increase on empathy in women with BPD and healthy women. To induce social exclusion, we randomized 98 women with BPD and 98 healthy women to either an exclusion or an overinclusion (control) condition of Cyberball, a virtual ball game. Subsequently, participants underwent the Multifaceted Empathy Test (MET), which assesses cognitive and emotional empathy. There was no increase in cortisol release after Cyberball. Cognitive empathy did not differ between groups or conditions. Women with BPD reported lower emotional empathy for positive emotions (group by valence interaction), but not for negative emotions. Exploratory analyses suggested that this effect might be more pronounced after social exclusion. Our results confirm previous findings that cognitive empathy does not differ between women with BPD and healthy women and extend this evidence to social exclusion. Emotional empathy in women with BPD seems to be more sensitive to the effects of stress or ambiguous social situations. Specifically, emotional empathy seems to be reduced for positive emotions, and might further decline after social exclusion. Empathic reactions to emotional stimuli of different valences and to specific emotions should be further investigated.

Porcine blood cell and brain tissue energy metabolism: Effects of "early life stress"

Background: Early Life Stress (ELS) may exert long-lasting biological effects, e.g., on PBMC energy metabolism and mitochondrial respiration. Data on its effect on brain tissue mitochondrial respiration is scarce, and it is unclear whether blood cell mitochondrial activity mirrors that of brain tissue. This study investigated blood immune cell and brain tissue mitochondrial respiratory activity in a porcine ELS model. Methods: This prospective randomized, controlled, animal investigation comprised 12 German Large White swine of either sex, which were weaned at PND (postnatal day) 28-35 (control) or PND21 (ELS). At 20-24 weeks, animals were anesthetized, mechanically ventilated and surgically instrumented. We determined serum hormone, cytokine, and "brain injury marker" levels, superoxide anion (O₂ ^•¯) formation and mitochondrial respiration in isolated immune cells and immediate post mortem frontal cortex brain tissue. Results: ELS animals presented with higher glucose levels, lower mean arterial pressure. Most determined serum factors did not differ. In male controls, TNFα and IL-10 levels were both higher than in female controls as well as, no matter the gender in ELS animals. MAP-2, GFAP, and NSE were also higher in male controls than in the other three groups. Neither PBMC routine respiration and brain tissue oxidative phosphorylation nor maximal electron transfer capacity in the uncoupled state (ETC) showed any difference between ELS and controls. There was no significant relation between brain tissue and PBMC, ETC, or brain tissue, ETC, and PBMC bioenergetic health index. Whole blood O₂ ^•¯ concentrations and PBMC O₂ ^•¯ production were comparable between groups. However, granulocyte O₂ ^•¯ production after stimulation with E. coli was lower in the ELS group, and this effect was sex-specific: increased O₂ ^•¯ production increased upon stimulation in all control animals, which was abolished in the female ELS swine. Conclusion: This study provides evidence that ELS i) may, gender-specifically, affect the immune response to general anesthesia as well as O₂ ^•¯ radical production at sexual maturity, ii) has limited effects on brain and peripheral blood immune cell mitochondrial respiratory activity, and iii) mitochondrial respiratory activity of peripheral blood immune cells and brain tissue do not correlate.

Affective Touch and Regulation of Stress Responses

Much has been documented on the association between stress and health. Both direct and indirect pathways have been identified and explored extensively, helping us understand trajectories from healthy individuals to reductions in well-being, and development of preclinical and disease states. Some of these pathways are well established within the field; physiology, affect regulation, and social relationships. The purpose of this review is to push beyond what is known separately about these pathways and provide a means to integrate them using one common mechanism. We propose that social touch, specifically affective touch, may be the missing active ingredient fundamental to our understanding of how close relationships contribute to stress and health. We provide empirical evidence detailing how affective touch is fundamental to the development of our stress systems, critical to the development of attachment bonds and subsequent social relationships across the life course. We will also explore how we can use this in applied contexts and incorporate it into existing interventions.

Physiological stress reactivity in pediatric cancer survivors treated with chemotherapy

Children who experience early life stress demonstrate changes to their stress responses, which may modulate long-term health. Childhood cancer presents significant stress during diagnosis, treatment, and survivorship. We hypothesized that children who have completed chemotherapy treatment for ALL will demonstrate altered hormone patterns in response to a stressor compared with healthy controls. Twelve pediatric ALL survivors and 12 healthy controls completed the Trier Social Stress Test. Salivary samples, heart rate, and self-report ratings of stress were collected at baseline, pretest, and posttest. Between group comparison showed baseline (interleukin [IL]-8) was significantly higher in the survivor group versus controls (survivors: 89.9, 40.1-544.9 pg ml^-1 ; controls: 30.7, 5.6-241.9 pg ml^-1 , p = .001) as was peak (IL-8) (survivors: 147.1, 71.6-1177.6 pg ml^-1 ; controls: 75.5, 28.6-698.6 pg ml^-1 ). Peak salivary alpha-amylase (sAA) concentration was significantly lower in the survivor group (survivors: 69.3, 19.4-195.5 U ml^-1 ; controls: 91.2, 27.7-213.7 U ml^-1 ; p = .04). Repeated measures ANOVA revealed significant main effects for time on cortisol (F_{(2.35, 50.81)}  = 5.9, p < .01), sAA (F_{(1.56, 33.17)}  = 6.6, p < .01), stress ratings (F_{(3.42, 88.14)}  = 53.4, p < .001), and heart rate (F_{(8, 83)}  = 16.8, p < .05). Significant main effects for group were observed for IL-8 (F_{(1, 23)}  = 8.2, p < .01) and tumor necrosis factor-α (F_{(1, 23)}  = 6.8, p < .05). Significant interaction effects for group × time were found for sAA (F_{(5, 106)}  = 2.8, p < .05). Our results indicate that childhood ALL survivors have similar responses to stress as healthy controls, but lower sympatho-adrenal-medullary reactivity. Therefore, altered stress regulation may present a pathway modulating long-term health in this population.

Race moderates the association between adult attachment avoidance and the cortisol awakening response among young sexual minority men

Adult attachment, or the ways in which individuals develop and maintain trusting and loving relationships with peers and romantic partners, has been demonstrated to influence hypothalamic-pituitary-adrenal (HPA) axis functioning among young sexual minority men (YSMM). Theory and preliminary evidence suggest that differences in the lived experiences of White and Black sexual minority young adults may influence the way in which adult attachment influences the HPA-axis functioning. We sought to further this field of inquiry by examining if race moderates the association between adult attachment insecurity (i.e., avoidance and anxiety) and HPA-axis functioning among YSMM. Sixty-three YSMM participated in a 5-day daily diary study in which they completed a baseline survey to assess adult attachment orientation and provided saliva samples 4 times per day over a 5-day period in order to measure cortisol across the day. Three-level hierarchical linear modeling was used to examine the association between adult attachment, the cortisol awakening response (CAR), diurnal cortisol, and the moderating effect of race. We found no main effect of attachment anxiety or avoidance on HPA-axis functioning. However, we found that race moderated the association between adult attachment avoidance and the CAR such that Black YSMM with higher attachment avoidance had a lower CAR as compared to White YSMM. Results suggest that there may be key differences between White and Black YSMM men's lived experiences that should be explored in future research.

Salivary cortisol, perceived stress and coping strategies: A comparative study of working and nonworking women

AIMS

This study investigated stress levels and coping strategies among working and nonworking women in the United Arab Emirates.

BACKGROUND

Stress levels in working and nonworking women have previously been studied, but few studies used cortisol to measure stress or examined how coping strategies affect stress levels.

METHODS

We employed a cross-sectional design with a convenience sample of women aged 20-65 years. Information on women's sociodemographic characteristics, perceived stress (using the Perceived Stress Scale) and coping strategies (using the Brief-COPE) was collected. Participants' morning (07:00-08:00) and evening (19:00-20:00) cortisol levels were measured using unstimulated saliva samples.

RESULTS

In total, 417 working and 403 nonworking women participated in this study. More nonworking women reported high stress levels than working women (14.1% vs. 4.1%, p = .001). Working women reported more use of informational support and venting to cope with stress compared with nonworking women (94.0% vs. 88.1%, p = .001). More nonworking women had impaired morning (<0.094 mg/dl) and evening (>0.359 mg/dl) cortisol compared with working women (58.1% vs. 28.5% and 41.7% vs. 18.0%, respectively). Compared with working women, nonworking women had 3.25 (95%CI: 2.38, 4.47) and 3.78 (95%CI: 2.65, 5.43) times the odds of impaired morning and evening cortisol, respectively.

CONCLUSION

Nonworking women exhibited higher levels of stress than working women. There is an urgent need to support nonworking women to manage stress through appropriate awareness campaigns and public health policies.

IMPLICATIONS FOR MANAGEMENT

Policymakers and community leaders should consider the mental health of nonworking women as a priority in planning public health policies and programmes. Nurse managers must have a voice in reforming public health policy to support early assessment and management of stress among nonworking women.

Stress reactivity in salivary cortisol and electrocardiogram in adolescents: Investigating sleep disturbances and insomnia

This study examined the role of sleep disturbances and insomnia in the context of stress reactivity in adolescence. One-hundred and thirty-five 11-18 year olds (M_age  = 14.2 years, SD = 1.9, 52% female) completed the Trier Social Stress Test for Children. Salivary cortisol and subjective stress ratings were collected at six time points, and heart rate as well as heart rate variability were measured pre-, during and post-stress induction. Additionally, sleep disturbances and insomnia diagnosis were assessed by a self-report questionnaire and a sleep interview. Robust mixed models investigated if adolescents with compared with adolescents without (a) sleep disturbances and (b) insomnia differ regarding cortisol, heart rate, heart rate variability and psychological stress reactivity considering gender effects. The results indicated that boys with high sleep disturbances showed higher cortisol activity compared with boys with low sleep disturbances, B = 0.88, p < 0.05. Moreover, in boys with insomnia, heart rate and alpha 1 significantly differ less than in boys without insomnia. These findings support the notion of sex differences regarding the association between poor sleep and increased activity of the hypothalamic-pituitary-adrenal axis, and a less adaptable autonomic nervous system in boys in response to an experimental social stress task.

Child maltreatment and hypothalamic-pituitary-adrenal axis functioning: A systematic review and meta-analysis

Alterations in hypothalamic-pituitary-adrenal (HPA) axis and its effector hormone cortisol have been proposed as one possible mechanism linking child maltreatment experiences to health disparities. In this series of meta-analyses, we aimed to quantify the existing evidence on the effect of child maltreatment on various measures of HPA axis activity. The systematic literature search yielded 1,858 records, of which 87 studies (k = 132) were included. Using random-effects models, we found evidence for blunted cortisol stress reactivity in individuals exposed to child maltreatment. In contrast, no overall differences were found in any of the other HPA axis activity measures (including measures of daily activity, cortisol assessed in the context of pharmacological challenges and cumulative measures of cortisol secretion). The impact of several moderators (e.g., sex, psychopathology, study quality), the role of methodological shortcomings of existing studies, as well as potential directions for future research are discussed.

Neighborhood Disadvantage Associated With Blunted Amygdala Reactivity to Predictable and Unpredictable Threat in a Community Sample of Youth

BACKGROUND

Childhood socioeconomic disadvantage is a form of adversity associated with alterations in critical frontolimbic circuits involved in the pathophysiology of psychiatric disorders. Most work has focused on individual-level socioeconomic position, yet individuals living in deprived communities typically encounter additional environmental stressors that have unique effects on the brain and health outcomes. Notably, chronic and unpredictable stressors experienced in the everyday lives of youth living in disadvantaged neighborhoods may impact neural responsivity to uncertain threat.

METHODS

A community sample of children (N = 254) ages 8 to 15 years (mean = 12.15) completed a picture anticipation task during a functional magnetic resonance imaging scan, during which neutral and negatively valenced photos were presented in a temporally predictable or unpredictable manner. Area Deprivation Index (ADI) scores were derived from participants' home addresses as an index of relative neighborhood disadvantage. Voxelwise analyses examined interactions of ADI, valence, and predictability on neural response to picture presentation.

RESULTS

There was a significant ADI × valence interaction in the middle temporal gyrus, anterior cingulate cortex, hippocampus, and amygdala. Higher ADI was associated with less amygdala activation to negatively valenced images. ADI also interacted with predictability. Higher ADI was associated with greater activation of lingual and calcarine gyri for unpredictably presented stimuli. There was no three-way interaction of ADI, valence, and predictability.

CONCLUSIONS

Neighborhood disadvantage may impact how the brain perceives and responds to potential threats. Future longitudinal work is critical for delineating how such effects may persist across the life span and how health outcomes may be modifiable with community-based interventions and policies.

Impact of the covid-19 pandemic on the psychological status and cortisol level of multiple sclerosis patients

This study aimed to compare the changes in psychological status and cortisol level between multiple sclerosis (MS) patients and a healthy control group (HC). One hundred and fifty-five MS patients and 165 HC subjects had completed questionnaires consisting of 36-Item short health survey (SF-36), Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory-II (BDI-II), and fatigue severity score (FSS) before and after (one year from onset) COVID-19 pandemic. The salivary cortisol level was also measured again in 26 MS patients and 14 control individuals. MS patients had lower scores of mental and physical components of quality of life (MCS and PCS), but higher HAM-A, FSS, and BDII scores than HC Before and after COVID-19. There were significant changes in scores of MCS, BDI-II, HAM-A, and FSS after the COVID-19 outbreak in MS patients, but not in PCS score. In HC group, we observed significant changes in scores of MCS, BDI-II, and FSS, but not in scores of PCS and HAM-A. Compared to HC, the MS patients reported greater deterioration in the overall mental health component of their health-related quality of life, and their levels of anxiety and fatigue over the study period. The change of cortisol levels was non-significant with a small effect size.

Childhood Trauma and Cortisol Reactivity: An Investigation of the Role of Task Appraisals

Background

Childhood adversity is linked to adverse health in adulthood. One posited mechanistic pathway is through physiological responses to acute stress. Childhood adversity has been previously related to both exaggerated and blunted physiological responses to acute stress, however, less is known about the psychological mechanisms which may contribute to patterns of physiological reactivity linked to childhood adversity.

Objective

In the current work, we investigated the role of challenge and threat stress appraisals in explaining relationships between childhood adversity and cortisol reactivity in response to an acute stressor.

Methods

Undergraduate students (n = 81; 61% female) completed an online survey that included general demographic information and the Risky Families Questionnaire 24 h before a scheduled lab visit. In the lab, a research assistant collected a baseline salivary cortisol sample. Following the baseline period, participants were read instructions for the Trier Social Stress Test (TSST), a validated psychological lab stressor. Next, they completed a challenge vs. threat task appraisal questionnaire and completed the speech and math portion of the TSST. Twenty minutes following the start of the TSST, a second salivary sample was collected to measure changes in salivary cortisol following the TSST.

Results

Linear regression analyses adjusted for age, sex, childhood socioeconomic status (SES), and baseline cortisol levels, showed childhood adversity associated with changes in cortisol levels [B = –0.29 t(73) = –2.35, p = 0.02, R^2=0.07]. Linear regression analyses controlling for age, sex, and childhood SES showed childhood adversity associated with both challenge [B = –0.52 t(74) = –5.04, p < 0.001, R^2=0.24] and threat [B = 0.55 t(74) = 5.40, p < 0.001, R^2=0.27] appraisals. Significant indirect effects of childhood trauma on cortisol reactivity were observed through challenge appraisals [B = –0.01 (95% confidence interval = –0.02, –0.003)], and threat appraisals [B = –0.01 (95% confidence interval = –0.01, –0.003)].

Conclusion

Childhood adversity may contribute to blunted cortisol reactivity, a pattern of response which is linked to obesity, addiction, and other behavior-related diseases. Our findings suggest that this relationship is in part a product of stress appraisals.

Associations of childhood and adult adversity with daily experiences in adulthood

Data from 213 adults were analysed to test the stress accumulation and stress sensitization models as they relate to daily mood, health behaviours and social interactions. Adults reported on childhood adversity, past year adversity, and daily experiences on 14 evenings. Results largely supported the stress accumulation and not stress sensitization model such that childhood and past year adversity had independent but not synergistic effects on daily experiences. Both adversity measures were independently associated with greater daily negative affect and negative affect variability. Childhood adversity independently associated with greater mean variability in daily positive affect. Past year adversity was associated with more daily social activities, greater odds of reporting interpersonal tension at least once, and daily tension. Although childhood adversity was associated with greater odds of sharing about one's day at least once, past year adversity was associated with more daily sharing and childhood adversity with less. Both measures were unrelated to daily health behaviours except childhood adversity was associated with lower odds of being a current drinker. The only support for the stress sensitization model was number of daily cigarettes among smokers. Our findings suggest childhood and recent adversity independently relate to adults' daily experiences and should be considered jointly.

Exploring joint HPA-inflammatory stress response profiles in adolescent girls: Implications for developmental models of neuroendocrine dysregulation

Prior research has struggled to differentiate cortisol stress response patterns reflective of well-regulated versus dysregulated hypothalamic-pituitary-adrenal (HPA) axis function among adolescents. Here, we show how exploring profiles of joint HPA-inflammatory stress responsivity, and linking those profiles to pubertal development and peer stress exposure may aid such distinction. Adolescent girls (N = 157, Mage  = 14.72 years, SD = 1.38) at risk for psychopathology completed assessments of salivary cortisol and pro-inflammatory cytokines (i.e., tumor necrosis factor-α, interleukin-1β, and interleukin-6) prior to and following the Trier Social Stress Test. Adolescents, a close friend, and a caregiver completed questionnaire measures of peer stress and pubertal status. Multitrajectory modeling of adolescents' cortisol and cytokine levels revealed three profiles: low cortisol response-stably low cytokine (n = 75), high cortisol response-stably moderate cytokine (n = 47), and low cortisol response-stably high cytokine (n = 35). Relative to low cortisol response-stably low cytokine, adolescents exhibiting the high cortisol response-stably moderate cytokine profile were more advanced in their pubertal development, but presented with similarly low levels of peer stress exposure. Despite showing cortisol responses that were indistinguishable from low cortisol response-stably low cytokine, adolescents exhibiting the low cortisol response-stably high cytokine profile were more pubertally advanced, but also more likely to have experienced chronic peer strain (self-report) and relational peer victimization (close friend-report). These findings thus illustrate the potential value of taking a multisystem approach to studying adolescent stress responsivity and underscore the importance of considering developmental and social factors when interpreting cortisol stress response patterns. Ultimately, such work may help inform developmental models of neuroendocrine dysregulation and related risk for psychopathology.

Adverse childhood experiences (ACEs) relate to blunted cardiovascular and cortisol reactivity to acute laboratory stress: A systematic review and meta-analysis

Adverse childhood experiences (ACEs) are associated with poor future mental and physical health. Altered biological reactivity to mental stress may be a possible mechanism linking ACEs to poor health. However, it is not clear if ACEs relate to blunted or exaggerated stress reactivity. This meta-analysis aimed to determine whether exposure to ACEs is associated with cardiovascular and cortisol stress reactivity. A systematic review yielded 37 sources. Random-effects modelling tested the aggregate effects of 83 studies of the association between ACEs and stress reactivity. Exposure to ACEs was associated with relatively blunted cardiovascular and cortisol stress reactivity. Effect sizes did not vary as a function of sample sex or reactivity measure (e.g., heart rate, blood pressure, or cortisol). Meta-regression revealed preliminary evidence of greater blunting in samples of a younger age and samples reporting greater ACE exposure. Subgroup analyses for stress task, ACE measurement instrument, and sample race were not conducted because of a lack of between-study variability. Exposure to ACEs is associated with dysregulation of multiple components of the human stress response system.

Applied relaxation and cortisol secretion: findings from a randomized controlled indicated prevention trial in adults with stress, anxiety, or depressive symptoms

Previous research has shown that relaxation interventions can reduce distress, anxiety, and depression. The exact mechanisms that underlie the efficacy of relaxation interventions remain unresolved. This study aimed to investigate whether applied relaxation (AR) leads to changes in cortisol secretion and whether these effects mediate fewer symptoms due to AR. Data come from a randomized controlled preventive interventional trial (N = 277) with elevated tension/distress, anxiety, or depressive symptomatology. Participants were randomized to an intervention group (IG; n = 139, received AR training), or a non-interventional control group (CG, n = 138). Psychopathological symptoms were assessed with DASS-21 and diagnoses of mental disorders via DIA-X-5. Cortisol was measured as short-term index in saliva (six times/d for 2 d at pre-, post-, and follow-up [FU] assessment) and long-term index in hair samples (once at pre-assessment and FU, respectively). Data were analyzed as pre-specified secondary analyses of the randomized controlled trial (RCT) on completer basis (n = 134 CG, n = 102 IG), using multivariable-adjusted linear regression models and mediation analyses (the DASS-21 change in the IG vs. CG with cortisol (area under the curve [AUC]) as mediator). From pre- to post-assessment, total daily salivary cortisol (AUC) decreased more strongly in the IG vs. CG (β-coefficient: -13.83, 95% confidence interval [CI]: -26.85 to -0.81), but was rendered non-significant when adjusting for pre-assessment AUC. This effect was not found for the cortisol awakening response (CAR) or hair cortisol. There was no evidence for a mediation of cortisol (AUC). These findings provide little support for the idea that cortisol reductions explain the beneficial effects of AR on mental health.

Dissociable impact of childhood trauma and deployment trauma on affective modulation of startle

Trauma disorders are often associated with alterations in aversive anticipation and disruptions in emotion/fear circuits. Heightened or blunted anticipatory responding to negative cues in adulthood may be due to differential trauma exposure during development, and previous trauma exposure in childhood may also modify effects of subsequent trauma in adulthood. The aim of the current investigation was to examine the contributions of childhood trauma on affective modulation of startle before and after trauma exposure in adulthood (a combat deployment). Adult male participants from the Marine Resilience Study with (n = 1145) and without (n = 1312) a history of reported childhood trauma completed an affective modulation of startle task to assess aversive anticipation. Affective startle response was operationalized by electromyography (EMG) recording of the orbicularis oculi muscle in response to acoustic stimuli when anticipating positive and negative affective images. Startle responses to affective images were also assessed. Testing occurred over three time-points; before going on a 7 month combat deployment and 3 and 6 months after returning from deployment. Startle response when anticipating negative images was greater compared to pleasant images across all three test periods. Across all 3 time points, childhood trauma was consistently associated with significantly blunted startle when anticipating negative images, suggesting reliable effects of childhood trauma on aversive anticipation. Conversely, deployment trauma was associated with increased startle reactivity post-deployment compared to pre-deployment, which was independent of childhood trauma and image valence. These results support the hypothesis that trauma exposure during development vs. adulthood may have dissociable effects on aversive anticipation and arousal mechanisms. Further study in women and across more refined age groups is needed to test generalizability and identify potential developmental windows for these differential effects.

Salivary biomarkers of stress and inflammation in first graders in Côte d'Ivoire: Effects of a probiotic food intervention

This semi-randomized controlled trial examined the effects of a probiotic food supplement on cortisol and C-reactive protein (CRP) in a sample of 262 four-to seven-year-old children (56% girls) in two economically-disadvantaged schools in an urban setting in Côte d'Ivoire. For one semester, children in one school were randomized to receive a probiotic (N = 79) or placebo (N = 85) fermented dairy food each day they attended school; one child (due to medical reasons) and all children in the other school (N = 98) continued their diets as usual. Children provided two saliva samples at 11:30 on consecutive days at the end of the study. Analyses revealed that the probiotic group had lower cortisol than the placebo or diet-as-usual groups (p = .015); CRP levels were comparable across groups (p = .549). Exploratory analyses suggested that dose and regularity of consumption may impact the biomarkers as well. This study provides the first evidence that a probiotic milk product may lower cortisol in a sample of young, economically-disadvantaged children.

Childhood adversity and cortisol habituation to repeated stress in adulthood

BACKGROUND

Childhood adversity is a robust predictor of poor health outcomes in adulthood and hypothalamic-pituitary-adrenocortical (HPA) axis dysfunction may be a key mechanism explaining this association. However, little is known about the influence childhood adversity may exhibit on adult HPA axis habituation (i.e., decreased cortisol output in response to a repeated stressor), where HPA axis dysfunction can be inferred if habituation deviates from normal patterns.

METHODS

The current study used data from a larger study that examined the effects of stress management interventions on cortisol habituation to repeated stress. Eighty-three adults reported childhood adversity with the Adverse Childhood Experience scale and completed the Trier Social Stress Test (TSST) twice (48 h apart) scheduled after a 6-wk intervention period. Salivary cortisol was assessed pre-stressor and +25, +35, and +60 mins post-stressor onset during both visits.

RESULTS

Results indicated that childhood adversity was associated with a marginally larger decrease in total cortisol from visit 1 to visit 2 among men (i.e., habituation), but not women (i.e. non-habituation).

CONCLUSIONS

These findings suggest that childhood adversity may alter HPA axis habituation to repeated stress later in life, with possible sex differences. Future research should investigate whether HPA axis habituation to repeated stress may be a pathway through which childhood adversity affects adult health, and how it may affect men and women differently.

Mitochondria and early-life adversity

Early-life adversity (ELA), which includes maltreatment, neglect, or severe trauma in childhood, increases the life-long risk for negative health outcomes. Mitochondria play a key role in the stress response and may be an important mechanism by which stress is transduced into biological risk for disease. By responding to cues from stress-signaling pathways, mitochondria interact dynamically with physiological stress responses coordinated by the central nervous, endocrine, and immune systems. Preclinical evidence suggests that alterations in mitochondrial function and structure are linked to both early stress and systemic biological dysfunction. Early clinical studies support that increased mitochondrial DNA content and altered cellular energy demands may be present in individuals with a history of ELA. Further research should investigate mitochondria as a potential therapeutic target following ELA.